S02 St. Cloud O&C 36C26324R0040.pdf

PAGE 1 OF 79 1. REQUISITION NO.

2. CONTRACT NO. 3. AWARD/EFFECTIVE DATE 4. ORDER NO. 5. SOLICITATION NUMBER 6. SOLICITATION ISSUE DATE

a. NAME b. TELEPHONE NO. (No Collect Calls) 8. OFFER DUE DATE/TIME 31 January 2025

11 PM CDT

9. ISSUED BY CODE 10. THIS ACQUISITION IS UNRESTRICTED OR SET ASIDE: % FOR:

SMALL BUSINESS

HUBZONE SMALL

BUSINESS

SERVICE-DISABLED

VETERAN-OWNED

SMALL BUSINESS

WOMEN-OWNED SMALL BUSINESS

(WOSB) ELIGIBLE UNDER THE WOMEN-OWNED

SMALL BUSINESS PROGRAM

EDWOSB

8(A)

NAICS:

SIZE STANDARD:

11. DELIVERY FOR FOB DESTINA-

TION UNLESS BLOCK IS

MARKED

SEE SCHEDULE

12. DISCOUNT TERMS

13a. THIS CONTRACT IS A

RATED ORDER UNDER

DPAS (15 CFR 700)

13b. RATING

14. METHOD OF SOLICITATION

RFQ IFB RFP

15. DELIVER TO CODE 16. ADMINISTERED BY CODE

17a. CONTRACTOR/OFFEROR CODE FACILITY CODE 18a. PAYMENT WILL BE MADE BY CODE

TELEPHONE NO. UEI: EFT:

PHONE: FAX:

17b. CHECK IF REMITTANCE IS DIFFERENT AND PUT SUCH ADDRESS IN OFFER

18b. SUBMIT INVOICES TO ADDRESS SHOWN IN BLOCK 18a UNLESS BLOCK BELOW IS CHECKED

SEE ADDENDUM

19. 20. 21. 22. 23. 24.

ITEM NO. SCHEDULE OF SUPPLIES/SERVICES QUANTITY UNIT UNIT PRICE AMOUNT

(Use Reverse and/or Attach Additional Sheets as Necessary)

25. ACCOUNTING AND APPROPRIATION DATA 26. TOTAL AWARD AMOUNT (For Govt. Use Only)

27a. SOLICITATION INCORPORATES BY REFERENCE FAR 52.212-1, 52.212-4. FAR 52.212-3 AND 52.212-5 ARE ATTACHED. ADDENDA ARE ARE NOT ATTACHED.

27b. CONTRACT/PURCHASE ORDER INCORPORATES BY REFERENCE FAR 52.212-4. FAR 52.212-5 IS ATTACHED. ADDENDA ARE ARE NOT ATTACHED

28. CONTRACTOR IS REQUIRED TO SIGN THIS DOCUMENT AND RETURN _______________ 29. AWARD OF CONTRACT: REF. ___________________________________ OFFER COPIES TO ISSUING OFFICE. CONTRACTOR AGREES TO FURNISH AND DATED ________________________________. YOUR OFFER ON SOLICITATION DELIVER ALL ITEMS SET FORTH OR OTHERWISE IDENTIFIED ABOVE AND ON ANY (BLOCK 5), INCLUDING ANY ADDITIONS OR CHANGES WHICH ARE ADDITIONAL SHEETS SUBJECT TO THE TERMS AND CONDITIONS SPECIFIED SET FORTH HEREIN IS ACCEPTED AS TO ITEMS:

30a. SIGNATURE OF OFFEROR/CONTRACTOR 31a. UNITED STATES OF AMERICA (SIGNATURE OF CONTRACTING OFFICER)

30b. NAME AND TITLE OF SIGNER (TYPE OR PRINT) 30c. DATE SIGNED 31b. NAME OF CONTRACTING OFFICER (TYPE OR PRINT) 31c. DATE SIGNED

AUTHORIZED FOR LOCAL REPRODUCTION (REV. NOV 2021)

PREVIOUS EDITION IS NOT USABLE Prescribed by GSA - FAR (48 CFR) 53.212

7. FOR SOLICITATION

INFORMATION CALL:

STANDARD FORM 1449

SOLICITATION/CONTRACT/ORDER FOR COMMERCIAL PRODUCTS AND COMMERCIAL SERVICES

OFFEROR TO COMPLETE BLOCKS 12, 17, 23, 24, & 30

36C26324R0040

36C26324R0040

2 February 2024

Matthew Rose 651-293-3010

36C263 Department of Veterans Affairs

NETWORK 23 CONTRACTING OFFICE

316 Robert Street N. STE. 506 St. Paul MN 55101

X

623110

$34 million

N/A

X

36C618

St. Cloud VA Health Care System One Veterans Drive St. Cloud, MN 55415

See block 9

St. Cloud VA Health Care System Open and Continuous Nursing Home Medicare-based Solicitation 36C26324R0040.

This solicitation is issued under the authority of 38 U.S.C 1720 and FAR Part 15.

Successful offerors may be awarded an Indefinite-Delivery Indefinite-Quantity contract.

Period of Performance- up to five years.

See detailed proposal submission instructions and a list of counties eligible for potential contracts under this solicitation at E.2.

Y

Department of Veterans Affairs Financial Services Center PO Box 149971 Austin TX 78714-9971

See CONTINUATION Page

See CONTINUATION Page

1358 process

X 1

Matthew Rose Contracting Officer

Table of Contents

Section B- Continuation of SF 1449 Blocks

B.1 Contract Administration Data B.2 Performance Work Statement B.3 Records Management Obligations (NARA Language) B.4 Schedule of Items

Section C- Contract Clauses

C.1 52.212-4 Contract Terms and Conditions—Commercial Products and Commercial Services (Nov 2023) C.2 52.204-21 Basic Safeguarding of Covered Contractor Information Systems (Nov 2021) C.3 52.216-18 Ordering (Aug 2020) C.4 52.216-19 Order Limitations (Oct 1995) C.5 52.216-22 Indefinite Quantity (Oct 1995) C.6 52.217-8 Option to Extend Services (Nov 1999) C.7 VAAR 852.204-71 Information and Information Systems Security (Feb 2023) C.8 VAAR 852.216-71 Economic Price Adjustment of Contract Price(s) Based on a Price Index (Mar 2018) C.9 VAAR 852.222-70 Contract Work Hours and Safety Standards – Nursing Home Care for Veterans (May 2018) C.10 VAAR 852.237-70 Indemnification and Medical Liability Insurance (Oct 2019) C.11 52.252-2 Clauses Incorporated by Reference (Feb 1998) C.12 Mandatory Written Disclosures C.13 52.212-5 Contract Terms and Conditions Required to Implement Statutes or Executive Orders—Commercial Products and Commercial Services (Dec 2023)

Section D – Contract Documents, Exhibits, or Attachments

Section E- Solicitation Provisions

E.1 52.212-1 Instructions to Offerors—Commercial Products and Commercial Services (Mar 2023) E.2 Detailed Proposal Instructions (Addendum to FAR 52.212-1) E.3 52.204-24 Representation Regarding Certain Telecommunications and Video Surveillance Services or Equipment (Nov 2021) E.3 52.209-7 Information Regarding Responsibility Matters (Oct 2018) E.4 52.216-1 Type of Contract (Apr 1984) E.5 52.233-2 Service of Protest (Sep 2006) E.6 52.252-1 Solicitation Provisions Incorporated by Reference (Feb 1998) E.7 52.212-2 Evaluation- Commercial Products and Commercial Services (Nov 2021) E.8 52.212-3 Offeror Representations and Certifications—Commercial Products and Commercial Services (Nov 2023)

36C26324R0040 | St. Cloud Open and Continuous Nursing Home Solicitation Section B.1 – Contract Administration Data

Section B- Continuation of SF 1449 Blocks

B.1 Contract Administration Data

1. Contract Administration: All contract matters will be handled by the following individuals:

Government Contractor Name To be determined at award

Title Contracting Officer / Contract Specialist

Address 316 Robert Street N. STE 506

Email To be determined at award

Phone To be determined at award

Government and Contractor points of contact may be changed at any time by written notice to the other party. A modification to the contract will not be required.

2. Contractor Remittance Address: All payments by the Government to the contractor will be made in accordance with FAR 52.232-33, Payment by Electronic Funds Transfer—System for Award Management.

3. Invoices: Invoices will be submitted monthly in arrears. See B.2 PWS 11.6 Contractor Billing for details.

4. Solicitation Amendments: The offeror acknowledges receipt of amendments to the Solicitation numbered and dated as follows:

Amendment Number Date

None currently

Section B.2 – Performance Work Statement (PWS)

B.2 Performance Work Statement [This solicitation will be used to award multiple contracts. The yellow highlights indicate location specific information that will be finalized prior to award.]

1. Overview

1.1. Services Rendered at VA Per Diem Rates. Upon acceptance of a VA patient by the Contractor, if and when requested by the VA Contracting Officer or Ordering Officer when delegated, the Contractor will furnish all supplies and services herein described, at the per diem rates for the “Levels of Care” specified in the Schedule of Items of this Contract.

1.1.1. The VA “Levels of Care” are defined in an attachment in Section D.1 of the solicitation and the Contract. VA is obligated only to the extent authorized if placement of patients is made in accordance with the terms specified in the Contract.

1.2. Ordering. Orders may be issued by Ordering Officers to place Veterans in Nursing Homes utilizing the CPRS system at VA hospital sites. Ordering Officer Contact information is as follows:

Ordering Officer Name:

Address

Telephone number

E-mail address

Facsimile number

1.3. Introduction. The Community Nursing Home (Contractor) program is a key component of the Veterans Health Administration (VHA) continuum of care.

1.3.1. Contractor agrees to provide in accordance with the terms and conditions stated herein to the U.S. Department of Veterans Affairs [SITE NAME] Health Care System, in [CITY AND STATE] at the prices specified in the section titled Schedule of Items of this Contract.

1.3.2. Nursing home facilities in the Contractor program will cooperate with VA staff in referral of appropriate Veterans for care and accept Veterans of which they have the capability/capacity to care.

1.3.3. The term, “facilities” includes but isn’t limited to: rooms, wards, sections, eating areas, drinking fountains, entrances, and other like areas.

2. Contractor Responsibilities

2.1. General. Nursing home facilities in the Contractor program will ensure that care meets the health needs and promotes the maximum well-being of VA patients.

2.1.1. Nursing home care will be furnished to ensure the total medical, nursing, and psychosocial needs of VA beneficiaries.

2.1.2. All nursing home facilities in VA’s Contractor program must maintain a current Center for Medicare and Medicaid Services (CMS) certification (Medicare and/or Medicaid) and a current State nursing home license.

2.1.3. VA often has a particular need for specialty care services in the Contractor program. The VA requires Contractors to have bed capacity to ensure their ability to take referrals when requested.

2.1.4. Contractor also must be able to accept VA referrals in a timely fashion (ideally within 24 hours of request).

2.1.5. Provider visits will be available at the rate of one (1) visit per month.

2.1.6. Laboratory, x-ray, and other special services will be available to VA patients as needed.

2.1.7. In addition, the care provided will include room, meals, nursing care, and other services or supplies commensurate with the VA-authorized level of care, without extra charge.

2.1.8. Duly authorized representatives of VA will provide quality oversight visits to Veterans placed to assure continuity of care and to assist in the Veterans’ transition back into the community.

2.1.9. These visits do not substitute or relieve the Contractor in any way of the responsibility for the daily care and medical treatment of the Veteran.

2.1.10. The per diem rate(s) established in this Contract will include the cost of:

A. primary medical care, B. one (1) provider visit per month and needed consultation, C. drugs and routine supplies, D. laboratory, x-ray, and other special services authorized by VA, unless otherwise specifically excepted (see Schedule of Items in this Contract for details regarding per diem rates and coverage).

2.1.11. Full attention will be given to motivating and educating patients to achieve and maintain independence in the activities of daily living.

2.1.12. Every effort will be made to keep patients ambulatory and to achieve an optimal level of self-care.

3. Termination of Services. VA reserves the right to remove any or all VA patients from the Contractor at any time when it is determined to be in the best interest of VA or the patients without additional costs to the Government.

4. VA Authorizations. Authorization for nursing home care will be submitted on VA Form 10-7078, “Authorization and Invoice for Medical and Hospital Services.”

4.1. Each authorization validity period will be noted on the VA Form 10-7078 with a beginning and end date.

4.2. Any extension to the original authorization validity period, regardless of the number of days, requires a new VA Form 10-7078.

5. Rate Basis. VA will utilize the appropriate Resource Utilization Grouping (RUG) rate(s) as a guide to determine VA rates.

5.1. The VA rate will include the cost of medical care, routine medications, laboratory, x-ray, therapy (ies), and other special services authorized by VA, unless otherwise specifically exempted.

5.2. VA will Contract for appropriate categories of care using Resource Utilization Groups (RUGs- IV) as a reference or guide.

5.3. The Level of Care classification and associated per diem rates will remain in effect for each placement until and unless one of the following events takes place:

5.3.1. Re-hospitalization that may be associated with a change in level of care;

5.3.2. Need for more intensive therapy;

5.3.3. Significant change in condition; or

5.3.4. Classification changes may also occur based on a determination by VA.

5.4. Medicare Rates. The per diem rate will be established by utilizing the current Medicare rate including the cost of supplies, services, and equipment above that which is provided under Medicare.

https://www.va.gov/vaforms/medical/pdf/VHA-10-7078-fill.pdf https://www.va.gov/vaforms/medical/pdf/VHA-10-7078-fill.pdf https://www.va.gov/vaforms/medical/pdf/VHA-10-7078-fill.pdf

5.4.1. Medicare rates established after the Effective Date of this Contract will be incorporated via a unilateral modification to the Contract.

A. Rates will be updated at most once annually.

B. The RUGS IV rates include:

1) room,

2) board,

3) routine nursing care,

4) rehabilitation therapy (including physical, speech and occupational therapy),

5) respiratory therapy,

6) oxygen therapy,

7) medical and nursing supplies (including items such as urological and colostomy supplies),

8) most oral medications,

9) most items of durable medical equipment (excluding ventilators),

10) x-rays, and

11) routine laboratory tests (see Schedule of Items in this Contract for details on rates).

C. Any additional requests for payment to the all-inclusive per diem rates must be pre-approved.

5.5. Contractor’s Minimum Data Set (MDS) Assessment for Medicare: Contractor’s Minimum Data Set (MDS) assessment will be completed on the same schedule as the current Medicare MDS- Scheduled assessments, including close of therapy (COT) assessments.

5.5.1. Classification changes will be approved by VA, dependent on projection for short-term or long-term residence, and adhering to the most current MDS frequency guidelines from Medicare.

5.5.2. The applicable per diem rate will continue until the next assessment.

5.5.3. This request should be submitted on the Level of Care Authorization Form provided to the facility.

5.5.4. VA will make the determination whether classification changes require readmission to VA.

5.5.5. VA staff will audit approximately 20% of the MDS assessments.

6. Primary Medical Coverage. The assigned Contractor provider is the primary medical provider during the nursing home stay and is responsible for writing or approving admission and all other orders as soon as the Veteran arrives at the Contractor.

6.1. Contractor provider is responsible for general medical care, urgent evaluation and intervention.

6.2. Provider visits will be according to the Center for Medicare and Medicaid Services (CMS) guidelines.

6.3. The assigned nursing home provider will provide timely care following the most current CMS guidelines; arranging 24/7 access for patient care; arranging easy access to VA staff for consultation;

providing timely response to calls and arranging for timely provider back-up according to OBRA guidelines (42 CFR 483.40, OBRA Guidelines).

7. Rehabilitation Criteria. All therapy provided under this Contract will be individual therapy, rather than group therapy, unless otherwise ordered by the authorizing VA facility.

7.1. Therapy may require pre-approval by VA before services are provided.

7.2. Medical Restorative criteria will be used for physical therapy, occupational therapy, and speech therapy.

7.3. Therapy must be skilled, relate to safety and be restorative according to Medicare criteria.

7.3.1. Description of Rehabilitative Therapy. The concept of rehabilitative therapy includes recovery or improvement in function and, when possible, restoration to a previous level of health and well-being.

A. Therefore, evaluation, re-evaluation and assessment documented in the Progress Report should describe objective measurements which, when compared, show improvements in function, or decrease in severity, or justification for an optimistic outlook to justify continued treatment.

B. Covered therapy services will be rehabilitative therapy services unless they meet the criteria for maintenance therapy requiring the skills of a therapist.

7.3.2. Evaluations/re-evaluations should consider the following:

A. Establishment of treatment goals specific to the patient’s disability or dysfunction and designed to specifically address each problem identified in the evaluation;

B. design of a plan of care addressing the patient’s disorder, including establishment of procedures to obtain goals, determining the frequency and intensity of treatment;

C. continued assessment and analysis during implementation of the services at regular intervals;

D. instruction leading to establishment of compensatory skills; selection of devices to replace or augment a function (e.g., for use as an alternative communication system and short-term training on use of the device or system);

E. and patient and family training to augment rehabilitative treatment or establish a maintenance program.

F. Education of staff and family should be ongoing.

8. Emergency Care; Financial Responsibility; Advanced Directives. In emergencies, nursing home staff will utilize the 911 local emergency systems as for any resident.

8.1. Advance directives or living wills will be adhered to according to the Contractor physician’s orders.

8.2. When private hospitalization or emergency services are required, the patient, spouse, financial guardian or insurer is financially responsible.

8.3. Service-connected Veterans may qualify for VA coverage of emergency care provided the VA Health Care System (VAHCS) is contacted by the private hospital provider within 72-hours of admission on the first business day following a weekend or holiday.

8.4. This includes the cost of necessary transportation for such care.

9. HIPAA Compliance. HIPAA compliance is required.

9.1. Contractor must adhere to the provisions of Public Law 104-191, Health Insurance Portability and Accountability Act (HIPAA) of 1996 and the National Standards to Protect the Privacy and Security of Protected Health Information (PHI).

9.2. As required by HIPAA, the Department of Health and Human Services (HHS) has promulgated rules governing the security and use and disclosure of protected health information by covered entities, including the Department of Veterans Affairs (VA).

9.3. VACO has recognized CNH Contractors as not requiring a Business Associate Agreement

(BAA).

10. Quality Standards. To participate in VA’s Contractor Program, NHs are expected to have either:

10.1. a three-star overall rating, or

10.2. a two-star overall rating with a four star or greater quality measures score on the Centers for Medicare and Medicaid (CMS) Nursing Home Compare Web site (https://www.medicare.gov/nursinghomecompare/search.html).

10.3. NHs with lower scores may participate in the Contractor program only when specifically approved by the Deputy Under Secretary for Health for Operations and Management or designee.

10.4. All NHs in the Contractor Program must be certified by CMS under Title XVIII (Medicare) or Title XIX (Medicaid) or have received special approval from the Office of Geriatrics and Extended Care (GEC) Office.

10.4.1. NHs are responsible to the state of jurisdiction and CMS for the care provided.

10.4.2. VA does not regulate the care or inspect Contractors.

10.4.3. VA acts as an informed purchaser of care in order to purchase quality services for Veterans and enhance the Veterans’ experience in the home.

10.4.4. Contractor must maintain a current and unrestricted state license to operate as a skilled nursing facility.

10.4.5. Changes in the status of the licensure will be immediately reported to the [VA HOSPITAL’S] VA Home and Community Care Department at [PHONE #].

10.4.6. VA will monitor the professional care and administrative management of services provided under this Contract to VA beneficiaries.

11. QASP Metrics. Contractor will cooperate fully with VA’s quality improvement or quality assurance program functions relating to this Contract. The VA Contracting Officer will make all final determinations as to the Contractor’s reasonable cooperation with VA and compliance with these requirements.

11.1. Corrective Action Plan (QASP Metric #1)

Acceptable Quality Level: 100% of Corrective Action Plans must be created and implemented in accordance with the requirements listed in 11.1 Surveillance Method: Direct Observation, VA Review of State / Federal Reports & Documents, Periodic Inspection, Progress Meetings, Contractor Progress Reports Success Incentive: Positive past performance review Failure Disincentive: Negative past performance review, PWS section 14 remedies

11.1.1. Contractor will cooperate with timely development of Corrective Action Plans (CAPs) related to identified deficiencies and related to State, Federal or VA surveys.

11.1.2. Contractor will develop in the time period specified by VA timely and appropriate CAPs for VA surveys or investigation of complaints related to quality of care or sentinel events.

11.1.3. Contractor will also supply related documents or data as specified by VA.

11.1.4. The CAPs will include but are not limited to the following criteria and will:

A. Contain elements detailing how the Contractor will correct the deficiency as it relates to the individual;

B. Indicate how the Contractor will act to protect residents in similar situations;

C. Include the measures the Contractor will take or systems that will be altered to ensure that the problem will not recur.

1) Contractor must look at the system and determine if a change to the existing system will work, if a new system is necessary, or if a system does not exist and must be developed;

https://www.medicare.gov/nursinghomecompare/search.html

D. Indicate how the Contractor plans to monitor performance to make sure that solutions are permanent.

E. Provide dates when corrective action will be completed.

11.1.5. Contractor must develop and implement a quality assurance tool for ensuring that correction is achieved and sustained.

11.1.6. Failure to implement a quality assurance tool to sustain compliance will reflect that the Contractor has an ineffective quality assurance system; and

11.2. Life Safety Code (QASP Metric #2).

Acceptable Quality Level: Facility will maintain 100% compliance with Life Safety Code standards found in 11.2.

Surveillance Method: Direct Observation, VA Review of State / Federal Reports & Documents, Periodic Inspection, Progress Meetings Success Incentive: Positive past performance review Failure Disincentive: Negative past performance review, PWS section 14 remedies

11.2.1. Contractor’s building will conform to the most recent standards of the Life Safety Code (National Fire Protection Association Standard #101) in effect on the date of the Contract award.

11.2.2. In addition, the Contractor must maintain compliance with all applicable Federal, State, and local regulations.

11.2.3. The administrator of the Contractor is required to notify the VA Contracting Officer in writing at least thirty (30) calendar days prior to any planned facility changes that could impact the Life Safety Code and other safety features of the facility which were in existence at the time this Contract became effective.

11.2.4. The VA Contracting Officer will notify the VA Safety Manager responsible for the Life Safety Code inspection of the Contractor and he/she will review (inspect the facility if required) the proposed changes and provide necessary approval or disapproval of the Contractor to house Veterans during and/or after the proposed changes.

11.2.5. These changes may include but are not limited to:

A. Interior changes requiring VA approval. Some examples of facility changes that require the VA Contracting Officer notification are as follows:

1) interior finish,

2) corridor partitions/walls,

3) patient room doors,

4) linen or trash chutes,

5) exits, emergency lighting,

6) fire alarm systems,

7) automatic sprinklers,

8) smoke barrier walls or doors,

9) oxygen systems,

10) compressed gas storage,

11) HVAC, electrical and fuel gas systems;

B. Automatic sprinkler system. All VA Contracted Contractor facilities are to be fully-equipped with a fully-automatic sprinkler system installed in accordance with the National Fire Protection Association’s (NFPA) standards and be 100% sprinklered;

C. Natural disasters. In the event of a natural disaster (flood, tornado, etc.), the Contractor will communicate all action plans to VA.

1) The action plans will at a minimum identify temporary transfers of location, dates, and names of Veterans transferred; and

D. Major construction; additions; and renovations. Major construction including building additions or other renovations which may affect physical plant integrity;

1) WILL MEET latest NFPA 101 Life/Safety Code requirements as well as any additional VA Contractor construction standards in place at time of renovation or alteration.

11.3. Readmissions to VA, Death Notifications, Personal Belongings (QASP Metric #3) Acceptable Quality Level: Facility will maintain 100% compliance with standards found in 11.3.

Surveillance Method: Direct Observation, Periodic Inspection, Contractor Reports, Validated Complaints Success Incentive: Positive past performance review Failure Disincentive: Negative past performance review, PWS section 14 remedies.

11.3.1. VA beneficiaries who begin to require more than the level of care authorized by VA will be readmitted to an appropriate VA facility as determined and authorized by VA.

11.3.2. When such an admission is not feasible because of the nature of the emergency, hospitalization in a non-Federal facility may be accomplished provided VA authorization is obtained.

A. VA authorization must be obtained within 72-hours of admission of the patient to a non- Federal facility and notice of any Veteran death within 24-hours or immediately upon the first business day after a weekend or holiday.

B. If hospitalization of a non-emergency nature is required, readmission to a VA Medical Center may be accomplished as soon as the patient’s condition is sufficiently stabilized to permit admission to a VA Medical Center.

11.3.3. In the event of a death of any Veteran, the Contractor agrees to notify VA immediately of the death.

A. In the event a death of a VA beneficiary while receiving nursing home care under this Contract, the Contractor will promptly notify the VA facility which authorized admission and immediately assemble, inventory, and safeguard the patient’s personal effects.

B. The funds, deposits, and effects left by the VA patients upon the premises of the Contractor will be delivered by the Contractor to the person(s) entitled thereto under the laws currently governing the Contractor for making disposition of funds and effects left by patients, unless the beneficiary died without leaving a will, heirs or next of kin capable of inheriting.

11.3.4. When disposition has been made, the itemized inventory with annotation as to the disposition of the funds and effects will be immediately forwarded to the VA facility that authorized admission.

A. Should a deceased patient leave no will, heirs, or next of kin, his/her personal property and funds wherever located vests in and becomes the property of the United States in trust.

B. In these cases, the Contractor will forward an inventory of any such property and funds in its possession to the VA facility authorizing admission and will hold them (except articles of clothing necessary for proper burial) under safeguard until instructions are received from VA concerning disposition.

C. CMS regulations require retention of records for five (5) years when there is no requirement in State law.

11.4. Reportable Events (QASP Metric #4)

Acceptable Quality Level: Facility will maintain 100% compliance with standards found in 11.4.

Surveillance Method: Direct Observation, Periodic Inspection, Contractor Reports, Validated Complaints Success Incentive: Positive past performance review Failure Disincentive: Negative past performance review, PWS section 14 remedies

11.4.1. VA requires Contractors to submit a written report to the Contractor Coordinator to include the date of the occurrence and disposition:

11.4.2. Sentinel events. Sentinel events must be reported within 24 hours of occurrence.

Sentinel event includes, but is not limited to:

A. A fall resulting in death or injury;

B. Elopement resulting in a missing patient;

C. Patient abuse confirmed or under suspicion;

D. A medication error resulting in patient illness or injury;

E. Death or patient injury related to restraint (including side rails) use; or F. Death related to an unconfirmed or suspicious cause.

G. When there is a change of ownership of the Contractor;

11.4.3. Non-Sentinel adverse events. These must be reported by the end of the following business day. These include but are not limited to:

A. When there is a change of nursing home administrator or Director of Nursing/Director of Nursing Service;

B. substantiated allegations of mistreatment, neglect, abuse or misappropriation of Contractor Veterans or property;

C. Elopements of Contractor Veterans pursuant to state regulations;

D. Infectious outbreaks;

E. Resident to resident or resident to staff altercations involving a Contractor Veteran resulting in any injury that is other than minor; and

F. Copies of annual surveys or substantiated complaint investigations conducted by a State oversight agency;

11.4.4. When an adverse event occurs involving a Contractor Veteran which is not determined to be a Sentinel Event (but that the State requires that the occurrence be reported to the State), such event is also to be reported to VA’s Contractor program office.

11.4.5. Some adverse events, such as minor medication errors without catastrophic outcomes, are managed by the Contractor in the context of their quality improvement programs. It is not necessary for nursing homes to report such incidents to the Contractor program office.

11.5. VA Staff Access to Contractor Records (QASP Metric #5)

Acceptable Quality Level: Facility will maintain 100% compliance with standards found in 11.5.

Surveillance Method: Direct Observation, Periodic Inspection Success Incentive: Positive past performance review Failure Disincentive: Negative past performance review, PWS section 14 remedies

11.5.1. All medical records concerning the Veteran’s care in the Contractor will be readily accessible to VA.

11.5.2. Upon discharge or the death of a patient, medical records will be retained by the Contractor for a period of at least five (5) years following termination of care.

11.5.3. Patient records will be maintained in conformance with the Privacy Act of 1974 (5 U.S.C.

§ 552a).

11.5.4. A medical record will be maintained for each patient, which includes at least the following:

A. VAHCS Referral Package to the Contractor:

1) Copy of Physician Orders for Nursing Home Care;

2) CPRS Notes;

3) Discharge Summary w/ history & physical information and medication list;

4) Rehabilitation Progress Notes; and

5) Veteran Demographic Record which includes next of kin information.

6) Copy of Authorization Agreement (VAF 10-7078).

B. Nursing Home Clinical Record:

1) Contractor must maintain clinical records on each Veteran in accordance with accepted professional standards and practice.

2) The clinical record must be:

i. complete,

ii. accurately documented,

iii. readily accessible,

iv. systematically organized, and

v. legible.

3) Clinical records must contain at a minimum:

i. Sufficient information to identify the resident;

ii. A record of the Veteran’s assessments, including those assessments performed by services under the Contract with the Contractor;

iii. The plan of care and services including medication administration, provided by Contractor staff and services provided under the Contract with the Contractor;

iv. Interdisciplinary progress notes to include effect of care provided, Veterans’ response to treatment, change in condition, and changes in treatment;

v. Medical practitioner orders which are signed and dated;

vi. Allergies;

vii. Person to contact in an emergency situation;

viii. Name of attending medical practitioner; and

ix. Advanced directives if available.

C. Clinical Record Safeguards:

1) Contractor must safeguard clinical record information against loss, destruction, or unauthorized use.

2) If the Contractor maintains a Veteran’s record by computer, electronic signatures are acceptable.

3) If attestation is done on computer records, safeguards to prevent unauthorized access and to provide for reconstruction of information must be in place.

11.6. Contractor Billing (QASP Metric #6)

Acceptable Quality Level: Facility will maintain 100% compliance with standards found in 11.6.

Surveillance Method: Direct Observation, Periodic Inspection Success Incentive: Positive past performance review Failure Disincentive: Negative past performance review, PWS section 14 remedies

11.6.1. Invoices for board, care and ancillary services will be submitted promptly to the authorizing facility by the 15th calendar day following the end of the month in which services were rendered.

11.6.2. Contractor will promptly notify the VA Contractor Coordinator regarding any change in Veteran status:

A. discharge, transfer, against medical advice (AMA), hospitalization, death and/or any changes in payer source and any ability to complete timely billing.

11.6.3. All invoices must include the full name and address of the Contractor and will reflect:

A. the patient’s name, B. social security number, C. number of days billed, D. RUG category (ies), and E. agreed upon RUG rate (s).

F. Failure to include this information may result in delayed payment.

11.6.4. The current Contractor Billing Cover Sheet can be obtained from the Integrated Veterans Care (IVC) department at [PHONE #].

11.6.5. Pre-approved services billed by CMS procedures or CPT codes: All services which are pre-approved by VA as additional to the all-inclusive per diem rate must be billed according to CMS procedures or CPT codes.

A. Contractor will be reimbursed based on local guidelines and VA pricing schedules.

11.6.6. High-cost drugs: All requests for additional reimbursement for high-cost drugs and corresponding billing are due as soon as possible, but no later than 90 calendar days after use of products.

11.6.7. Corrected Invoices: Corrected invoices must be submitted for additional payment of any ancillary costs or changes to the original billing.

A. All corrected invoices must include all items that are affected by the change and should include the Contractor corrected claim form [VA Integrated Veterans Care (IVC) department, Phone#].

12. Acceptable Safety and Sanitation Practices. Acceptable safety and sanitation practices will be observed throughout the facility.

12.1.1. Contractor will address employee and patient safety practices through staff orientation, training, and adherence to related policy or procedures to provide a safe and clean environment.

13. Leave of Absence (LOA) – Bed-Hold Statement. For re-hospitalizations or therapeutic passes, VA will pay a bed hold.

13.1.1. VA will cover bed holds based on one of the following options as selected by the host VA medical center:

A. Two days/episode, pre-approved by VA when in the best interest of the Veteran and VA. Exceptions approved at VAMC level;

B. Bed holds not authorized per Medicare;

C. When deemed appropriate, VA will reimburse the Contractor 70% of applicable per diem rate for bed hold not to exceed two (2) days per episode, four (4) days total per month.

13.1.2. Bed-hold will begin the date the resident leaves the Contractor and full per diem will resume on the date of readmission to the Contractor.

A. Absences of fifteen (15) consecutive calendar days or more, whether in a VA or in a non- Federal facility require a new authorization agreement.

14. VA Actions Regarding Serious Quality of Care Deficiencies. In cases of serious deficiencies affecting the health or safety of Veterans, cases of continued uncorrected deficiencies, or violations of

QASP standards found in PWS section 11, VA will take one or more of the following actions in accordance with the terms and clauses of the Contract and applicable procurement regulations:

14.1. Increase VA staffing monitoring until the State survey agency clears the deficiency;

14.2. Suspend placement of Veterans in the Contractor;

14.3. Remove or transfer Veterans under the Contract from the subject Contractor;

14.4. Not renew the Contract; and/or

14.5. Terminate the Contract.

15. Specialty Services. Contractor will assume responsibility for arranging specialty care for Veterans (e.g., dental care, podiatry and ophthalmology).

16. VA Health Care System Consultation/Resources. [THE FOLLOWING PARAGRAPH SHOULD

BE TAILORED TO SUIT EACH SITE:]

16.1. Telephone Care Communications Systems (TCCS): For urgent same-day outpatient specialty care or for non-urgent scheduled clinic appointments/consultations, phone number [PHONE #] between 9 a.m. and 3 p.m. Monday through Friday, excluding holidays. If a same-day appointment is anticipated; please call as early as possible.

16.2. Admissions Conference Call Systems phone number [PHONE #]

16.3. For non-emergency consultation or /evaluation for admission to the [FACILITY NAME] VA Health Care System (after initial evaluation or intervention by the nursing home physician).

16.4. After hours, weekends and holidays: For urgent referrals or consultation contact the Admission Conference Call System number [PHONE #].

16.5. Transportation: Necessary transportation to and from the VA hospital for clinics, evaluation or hospitalization will be arranged and paid by the VA hospital for Contractor patients when requested.

For Clinic appointments, call [PHONE #].

17. Charitable Contributions. Contractor will not solicit contributions, donations, or gifts from patients or family members. Note: Established charitable fundraising activities of a Contractor fall outside the scope of this language.

18. Minimum Quantities; VA Payment. It is impossible to determine the exact or estimated amount, which will be expended under this Contract.

18.1. No obligation will be incurred by VA under this Contract, until authorizations are issued for nursing home care of specific beneficiaries.

18.2. VA agrees to make payment on a timely basis for services rendered in accordance with such authorizations upon receipt of proper invoices submitted by the Contractor as outlined in this Contract.

18.3. VA will make payment for the day a recipient enters the Contractor but not the day the recipient leaves a Contractor unless entrance and departure are on the same day, then payment will be made for one (1) day.

19. VA Payments. Payments made by VA under any Contract pursuant to this Contract, constitute the total cost of nursing home care.

19.1. No additional charges will be billed to Medicare (with the exception of hospice), Medicaid, or private insurance, the beneficiary or his/her family, either by the Contractor or any third-party furnishing services or supplies required for such care, unless and until specific prior authorization in writing is obtained from the VA facility authorizing placement.

19.2. The patient, family, and any other entitlement programs (e.g., Medicare, Medicaid, etc.) will not be billed for uncovered services or costs during the VA Contract period. This constitutes double-billing and Federal fraud.

19.3. Vendors who bill electronically using the HIPAA-compliant claims transactions must submit claims through the VA clearinghouse, Emdeon, using payer ID number 12115 for medical claims.

19.4. Vendors who are not able to use the HIPAA-compliant transactions are not required to do so.

Supporting information for monthly invoices will be mailed to:

Integrated Veterans Care (IVC) (mail code) ______________VA Health Care System Street City, State - Zip Code

(End of B.2 Performance Work Statement)

Section B.3 – Records Management Obligations (NARA Language)

B.3 Records Management Obligations (NARA Language) Website: https://www.archives.gov/records-mgmt/policy/records-mgmt-language

RECORDS MANAGEMENT OBLIGATIONS

A. Applicability This clause applies to all Contractors whose employees create, work with, or otherwise handle Federal records, as defined in Section B, regardless of the medium in which the record exists.

B. Definitions “Federal record” as defined in 44 U.S.C. § 3301, includes all recorded information, regardless of form or characteristics, made or received by a Federal agency under Federal law or in connection with the transaction of public business and preserved or appropriate for preservation by that agency or its legitimate successor as evidence of the organization, functions, policies, decisions, procedures, operations, or other activities of the United States Government or because of the informational value of data in them. The term Federal record:

1. Includes [Agency] records.

2. Does not include personal materials.

3. Applies to records created, received, or maintained by Contractors pursuant to their [Agency] contract

4. May include deliverables and documentation associated with deliverables.

C. Requirements

1. Contractor shall comply with all applicable records management laws and regulations, as well as National Archives and Records Administration (NARA) records policies, including but not limited to the Federal Records Act (44 U.S.C. chs. 21, 29, 31, 33), NARA regulations at 36 CFR Chapter XII Subchapter B, and those policies associated with the safeguarding of records covered by the Privacy Act of 1974 (5 U.S.C. 552a). These policies include the preservation of all records, regardless of form or characteristics, mode of transmission, or state of completion.

2. In accordance with 36 CFR 1222.32, all data created for Government use and delivered to, or falling under the legal control of, the Government are Federal records subject to the provisions of 44 U.S.C. chapters 21, 29, 31, and 33, the Freedom of Information Act (FOIA) (5 U.S.C. 552), as amended, and the Privacy Act of 1974 (5 U.S.C. 552a), as amended and must be managed and scheduled for disposition only as permitted by statute or regulation.

3. In accordance with 36 CFR 1222.32, Contractor shall maintain all records created for Government use or created in the course of performing the contract and/or delivered to, or under the legal control of the Government and must be managed in accordance with Federal law.

Electronic records and associated metadata must be accompanied by sufficient technical documentation to permit understanding and use of the records and data.

4. [Agency] and its contractors are responsible for preventing the alienation or unauthorized destruction of records, including all forms of mutilation. Records may not be removed from the legal custody of [Agency] or destroyed except for in accordance with the provisions of the agency records schedules and with the written concurrence of the Head of the Contracting Activity.

Willful and unlawful destruction, damage or alienation of Federal records is subject to the fines and penalties imposed by 18 U.S.C. 2701. In the event of any unlawful or accidental removal, defacing, alteration, or destruction of records, Contractor must report to [Agency]. The agency must report promptly to NARA in accordance with 36 CFR 1230.

https://www.archives.gov/records-mgmt/policy/records-mgmt-language

Section B.3 – Records Management Obligations (NARA Language)

5. Contractor shall immediately notify the appropriate Contracting Officer upon discovery of any inadvertent or unauthorized disclosures of information, data, documentary materials, records or equipment. Disclosure of non-public information is limited to authorized personnel with a need-to-know as described in the [contract vehicle]. Contractor shall ensure that the appropriate personnel, administrative, technical, and physical safeguards are established to ensure the security and confidentiality of this information, data, documentary material, records and/or equipment is properly protected. Contractor shall not remove material from Government facilities or systems, or facilities or systems operated or maintained on the Government’s behalf, without the express written permission of the Head of the Contracting Activity. When information, data, documentary material, records and/or equipment is no longer required, it shall be returned to [Agency] control or the Contractor must hold it until otherwise directed. Items returned to the Government shall be hand carried, mailed, emailed, or securely electronically transmitted to the Contracting Officer or address prescribed in the [contract vehicle]. Destruction of records is EXPRESSLY PROHIBITED unless in accordance with Paragraph (4).

6. Contractor is required to obtain the Contracting Officer's approval prior to engaging in any contractual relationship (sub-contractor) in support of this contract requiring the disclosure of information, documentary material and/or records generated under, or relating to, contracts.

Contractor (and any sub-contractor) is required to abide by Government and [Agency] guidance for protecting sensitive, proprietary information, classified, and controlled unclassified information.

7. Contractor shall only use Government IT equipment for purposes specifically tied to or authorized by the contract and in accordance with [Agency] policy.

8. Contractor shall not create or maintain any records containing any non-public [Agency] information that are not specifically tied to or authorized by the contract.

9. Contractor shall not retain, use, sell, or disseminate copies of any deliverable that contains information covered by the Privacy Act of 1974 or that which is generally protected from public disclosure by an exemption to the Freedom of Information Act.

10. The [Agency] owns the rights to all data and records produced as part of this contract. All deliverables under the contract are the property of the U.S. Government for which [Agency] shall have unlimited rights to use, dispose of, or disclose such data contained therein as it determines to be in the public interest. Any Contractor rights in the data or deliverables must be identified as required by FAR 52.227-11 through FAR 52.227-20.

11. Training. All Contractor employees assigned to this contract who create, work with, or otherwise handle records are required to take [Agency]-provided records management training. Contractor is responsible for confirming training has been completed according to agency policies, including initial training and any annual or refresher training

Section B.4 – Schedule of Items & Covered Services

B.4 Schedule of Items

1. Rate Determination: The VA is seeking preferred rates based on patient care need. VA rates are an all

-inclusive per diem rate. Items generally included or excluded in the per diem rate are listed in Table A, although some variances may apply in coverage. See B.2 PWS 5.4 for additional details regarding what is included in per diem determinations. The per diem rate(s) will apply throughout the term of this contract.

For current Contract rates please see Attachment 4: Medicare Pricing Schedule.

Table A

Service Covered by per-diem

Not covered by per diem

Notes

Lab Tests X

Laundry/Linen service X

Medications X See B.4 #4.

Nursing supplies X

Occupational Therapy X Pre-approval required, See B.4 #3.

Oxygen Therapy X

Pastoral Care X

Physical Therapy X Pre-approval required, See B.4 #3.

Private Room X See B.4 S #5.

Provider visits

(MD/NP)

1 per month Pre-approval required for additional visits, See B.4 #3.

Radiology Studies X

Respiratory Therapy X

Room and Board X

Routine nursing care X

Routine Podiatry Care X

Social Services X

Speech Therapy X Pre-approval required, See B.4 #3.

Therapeutic Recreational services

Ventilator Care X See B.4 #6.

Audiology Care X Pre-approval and special authorization required.

Custom Prosthetics X Pre-approval and special authorization required.

Dental Care X Pre-approval and special authorization required.

Dialysis X Pre-approval and special authorization required.

Durable medical Equipment

X Can be obtained through VA

Eye Care X Pre-approval and special authorization required.

Hospice Care X Pre-approval and special authorization required.

Hospitalizations X See B.2 PWS at 8, 11.3, 11.6.2.

Psychology Services X Pre-approval and special authorization required.

Specialized beds X Pre-approval and special authorization required.

Specialized Wound Care

X Pre-approval and special authorization required.

TPN/IV Therapy X Pre-approval and special authorization required.

Transportation X Pre-approval and special authorization required.

Urgent Care/Emergency Room visits

X See B.2 PWS at 8, 11.3.

2. RUGs IV Rates: In the Centers for Medicare and Medicaid Services (CMS) FY 2020 Skilled Nursing

Facility Prospective Payment System (SNFPPS) Final Rule, CMS replaced the existing case-mix classification methodology, the Resource Utilization Groups, Version IV (RUG-IV) model, with a revised case-mix methodology called the Patient-Driven Payment Model (PDPM) beginning on October 1, 2019.

Though VA may switch to PDPM in the future, this contract will continue to utilize RUGS IV rates.

3. RUGs Rate Calculation: CMS’s annual SNFPPS final rule will be used to determine the base RUGs rates. The current final rule can be found in the Federal Register at 87 FR 47502. New rates are created by multiplying the previous year’s RUGs rates against the newly published SNF Market Basket Update Factor. The RUGs national reference totals will also be modified by the final rule’s newly published labor-related share percentage. Lastly, each county receives a new wage index in the annual rule, which further adjusts the final figures. The Contracting Officer will obtain the adjusted numbers in order to provide an annual rate adjustment.

4. Annual Rate Adjustments Rate adjustments are made in accordance with the proper federal regulatory standards. These are used by the Contracting Officer to provide updated Contract rates in accordance with the EPA clause incorporated into the contract via VAAR 852.216-71. The Contracting Officer will provide this by issuing a unilateral modification providing a schedule with the updated rates. Rates will be updated at most once a year.

5. Rehabilitation Therapy: Any type of rehabilitation therapy (physical therapy, occupational therapy, speech therapy, etc.) requires the pre-approval of…